Landi F, Gambassi G, Pola R, Tabaccanti S, Cavinato T, Carbonin P U, Bernabei R
Istituto di Medicina Interna e Geriatria, Centro di Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
J Am Geriatr Soc. 1999 Dec;47(12):1430-4. doi: 10.1111/j.1532-5415.1999.tb01562.x.
To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals.
Quasi-experimental study with a 6-month follow-up.
Vittorio Veneto, a town in northern Italy.
One hundred fifteen frail older people who applied for integrated home care services.
Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated.
We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program.
After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre-implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28+/-23 days vs 18+/-15 days, respectively; P < .01) and for each admission (16+/-12 days vs 12+/-8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient.
The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.
探讨基于综合老年评估和病例管理的家庭护理计划对体弱老年人住院情况及费用的影响。
为期6个月随访的准实验研究。
意大利北部城镇维托里奥威尼托。
115名申请综合家庭护理服务的体弱老年人。
每位患者均采用家庭护理最低数据集进行评估，随后，由一名病例管理员和一个多学科团队根据评估结果提供社会和医疗服务。
我们确定了家庭护理计划实施后头6个月内所有受试者的住院次数和住院天数，并将其与计划实施前6个月这些患者的住院率进行比较。
实施综合家庭护理计划后，与实施前相比，住院次数显著减少（分别为56%对46%；P <.001），同时住院天数也减少，这在个体患者层面（分别为28±23天对18±15天；P <.01）以及每次住院方面（分别为16±12天对12±8天；P <.01）均有体现。这使得成本降低了29%，估计每位患者节省1260美元。
基于病例管理员指导下使用综合老年评估工具实施的综合家庭护理计划对住院情况有显著影响且具有成本效益。
